Author: AlerStallings

When it comes to evaluating a long-term care facility, certainly you want to find a place where you and your loved one feel comfortable with the environment and the care provided. While you can’t underestimate your gut feeling on a decision of this magnitude, sometimes it helps to have a set of questions that guide the discussion and help you feel confident that you’re making the right choice. Here are the top five we recommend: 

1.) What is the staffing ratio and your rate of turnover?

You’ll want to know there are enough staff on hand—specifically nursing staff like licensed practical nurses (LVNs and LPNs) and certified nursing assistants (CNAs)—to provide quality care.

As of this writing, Medicare.gov indicates that the national average for total number of nurse staff hours per nursing home resident per day is 3 hours and 46 minutes. You can use their search tool to see how nursing homes near you stack up. For some nursing homes, staff turnover rates are also displayed; however, if it’s not available, don’t be afraid to ask the nursing home directly. 

2.) Do you put a plan of care in writing for each resident?

This is a good opportunity to discuss: 

– Whether the facility can meet your loved one’s needs (be specific!) 

– If the facility offers progressive levels of care (such as ventilators or specialized Alzheimer’s and dementia care) 

– How often the plan of care is updated  

– What services are included, and which will incur an extra fee 

It’s important to have confidence that you or your loved one will receive the standard of care you expect within your budget and that changing needs will be addressed in a timely fashion. Having the plan in writing ensures that everyone on the care team is on the same page and expectations are documented.   

3.) Is there a licensed physician on staff? Can residents see their own physician if they want to? 

In the event of an acute medical problem, you’ll want to know who will respond (and how quickly). Find out if there is a physician on staff and how often they are on the premises. If your loved one would be required to see this physician, find out if you could meet them in advance to assess their bedside manner. If you’d prefer to use your own physician, confirm with both the nursing home and your doctor how rounding would work. 

4.) How do you ensure the emotional well-being of your residents? 

Sure, you’re evaluating the nursing home’s ability to physically care for your loved one, but it’s also important to consider how they’ll care for their mental health. Some things you may want to consider include: 

– The policy for visitors, such as hours and restrictions 

– The types of activities offered and their frequency 

– Whether religious services are available 

– Access to outdoor areas like patios and gardens 

– How often cultural events are offered 

– The quality of the dining program, including menus that feature diverse cuisines 

Simply put, consider what makes your loved one smile and make sure they’ll still have access to the things that give them joy. 

5.) How are your employees selected and vetted? 

With cases of elder abuse on the rise, you can never be too careful in evaluating the people and facilities who will be entrusted with the care of your loved one. Unquestionably, all employees should have their backgrounds checked and their qualifications verified by the facility as a condition of hire. Staff members should be clearly identified with name tags or security badges at all times. 

When you visit a facility, interact with staff at all levels, not just the marketing director who leads the tour. Get an impression of how they respond to patients and trust your instincts. If you notice an unpleasant smell in the facility, a lack of cleanliness, lax security measures, or employees that seem disengaged from the residents, those are important warning signs you shouldn’t ignore. 

Choosing a nursing home can be stressful, but knowledge is one of the most important ways to make the process easier. Don’t hesitate to take these questions with you when you visit a facility, so you can truly be in the moment and focused on your loved one. And above all else, know that though you may be concerned about whether you’ll make the right choice, the simple fact that you’re doing this important research means you’re already on the path. 

Even when you feel confident in the staff and capabilities of the nursing home you chose, it’s hard not to worry about the well-being of your loved one when you’re not there. That’s why it’s important for everyone with a family member in long-term care to know about a new law that took effect on March 23 of this year. It’s called Esther’s Law, and it permits nursing home residents and their representatives to authorize and install electronic monitoring devices in their rooms to keep an eye on their care.  

The law is named for Esther Piskor, who was tragically abused and neglected by nursing home staff in the final few years of her life. Her son, Steve, visited her often, yet staff never mentioned anything out of the ordinary about Esther’s care. He caught the abuse after placing a hidden camera in Esther’s room. Following Esther’s passing, he worked with lawmakers to create and pass the bill in his mother’s honor and empower other families to take similar measures to protect their loved ones. 

Because electronic monitoring impacts other parties—including nursing home staff and fellow residents, particularly those in a shared room—the decision to monitor has some caveats, which the law addresses. For example, the roommate of a resident who wishes to install electronic monitoring must consent to the monitoring before it can be installed. If a roommate cannot consent for themselves, consent may come from their representative. Roommates (or their representatives) also have the right to request conditions to protect their privacy. Those conditions must be honored, and the roommate can revoke their consent at any time. If a roommate does not want the electronic monitoring installed, the nursing home must move the resident requesting electronic monitoring to another room with the resident’s consent.  

As far as the facility is concerned, Esther’s Law allows for notification to be posted outside the resident’s room to inform those who enter that electronic monitoring is being conducted. A resident who uses electronic monitoring may not be retaliated against, nor may their decision be used against them in admissions or discharge. Further, facilities are prohibited from destroying, obstructing, or tampering with the monitoring system or its recordings.  

For many families, this law represents an opportunity to gain insight into the treatment of their loved ones and peace of mind. After working with Ohio families for years on nursing home protection and elder care, it’s a subject that’s close to our heart.  

If you’d like more information on Esther’s Law, contact the Ohio Department of Aging’s Long-Term Care Ombudsman Program at 1-800-282-1206 or OhioOmbudsman@age.ohio.gov.